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Power from the Cold - the definitive book about Whole Body Cryotherapy

"Power from the Cold" by Prof. Dr. sc. med. Winfried Papenfuß first published in 2005, available already in its 3rd edition in German finally came out in its 2nd English edition. For the first time one entire chapter is dedicated to the use of WBC in the context of the spa and wellness industry.

Prof. Papenfuß and the editiorial Edition k allowed us, to publish chapter 7.1, for which we want to express our gratefulness. If you'd like to order a copy of the complete book just follow the link "Power from the Cold".

7. Whole body cold exposure for primary diseaseprevention, in the spa industry, in programmes for generally promoting health and wellbeing, as well as in relation to naturopathic procedures

7.1 Basics

Whole body cold exposures at temperatures ranging from -100°C to -110°C are no longer restricted to purely therapeutic exposures. They are now applied more and more for preventive medicine as well as in many spa institutions renowned for their prophylactic and therapeutic facilities. Against the backdrop of other natural and preventive procedures, the general health beneficial and performance-optimising effects of cryoapplications have resulted in their increasing use to promote general wellbeing, often combined with the desire of optimising one’s abilities to work in their chosen profession. People these days are asking what they themselves can contribute to promote their own health, and what role their mental and physical wellbeing plays in this respect. From such generally outlined reasons, it now seems appropriate to ask the role which whole body cold exposures can play in this process. In addition, and this should not be overlooked, exposure to cold can now be accomplished in the icelab in a very comfortable form and environment, a fact which has contributed greatly to its acceptance, even in situations where its necessity is not dictated by a pathological indication (e.g. a painful inflammatory condition), and it is much rather intended to prevent disease, improve well-being or improve overall performance.

What determines the use of whole body cryoapplications in this respect? At this point we can refer briefly back to the effects described in other chapters of this book. Let’s start with the systemic effects that are triggered via neuronal reflex mechanisms. This is almost certainly the main reason why whole body cold exposures enjoy benefits over locally employed physical applications. Rather than inducing reactions which are either locally restricted or confined to individual organs, whole body cold exposures elicit complex responses that affect both the physique and the psyche. These can occur in the central and autonomic nervous systems, in the cardiovascular and respiratory systems, in hormonal regulation, with immune functions, in metabolism as well as in muscular and skin functions (figure 7.1). 

Concerning the effects of whole body cold applications on the central nervous system, only their influence on the control of chronic inflammatory processes(17, 18, 34) and the perception of pain(22, 53) by the brain initially played a role in the many studies and discussions about this topic. Now, however, many years of more recent clinical experience and scientific research(58, 63, 64, 65) have allowed us to abandon this what now seems unilateral approach. In general terms it can be said that whole body cryoapplications modulate activity levels in the brain. They contribute towards bringing about a balanced mental state. From a symptomatic viewpoint this is actually quite easy to establish since we know that sleeping patterns can improve, stress management can become more effective, overstrain syndromes can be manageable and the treatment of reactive depressive states can be effectively assisted. The mutual interactions between the central nervous system and the autonomic nervous system also play a role. The autonomic nervous system reacts differently to the effects of cold on the body surface in a way that depends largely on what the initial situation might be. With an excessively high level of agitation or arousal, i.e. when the sympathetic nervous system predominates, it is mainly the parasympathetic nervous system which becomes activated, especially via the effects of the cold on the facial skin, and it is this wing of the autonomic nervous system which actually reduces the levels of agitation or arousal. If on the other hand the general state of activity in the nervous system is too low, cold exposure can raise it (figure 7.2). The hormonal events associated with these reactions are discussed in detail below.

Studies into its cardiovascular and respiratory effects were already instigated when whole body cryotherapy was first introduced into the clinical field(16, 17, 18). In recent years in particular, major efforts have been made to substantiate these effects of whole body cold exposures further(5, 23, 24, 25, 26, 31, 39). Confirmed effects include the economisation of cardiac function, which already on its own can account for significant improvements in physical performance. Short-term exposure to cold also induces a desirable thermal conditioning of the blood vessels in the skin (alternating constriction and dilation) as an essential prerequisite for modulating blood pressure at excessively low levels and for strengthening the immune system, probably via the cold-induced increase in the numbers of immune cells brought about by periodic exposure to whole body cold. Oxygen supply and uptake is also increased(16, 74), probably as a result of the respiration stimulating effect of the cold stimulus, the cold and as such denser respired air in the cryotherapy chamber (icelab), and the detoning of the respiratory muscles (figure 7.3).

At this point I should write a few words about hormonal reactions(40, 73) and metabolism. Initially both adrenaline and noradrenaline increase in the blood. The adrenaline rise is very short and is basically a sign of the heightened state of agitation which is normally associated with entering the cryotherapy chamber. An increase in arterial blood pressure is also induced during and shortly after exposure to the cold. The increase in serum concentration of noradrenaline is probably due to the transmitter function which is stimulated by the cold exposure, which also brings about an increase in the pain threshold. There is also a significant reduction in the concentration of the stress hormones adrenocorticotropin (ACTH) and cortisol which positively affects stress management, sleep behaviour, well-being and the immune system amongst other effects. Elevated cortisol levels interfere with immune functions, but lowering of cortisol is beneficial for the immune system. An improvement in sleep behaviour usually means an increase in the proportion of deep sleep during the total time spent asleep. This has positive implications for the hormonal balance. We know for example that the quality of an individual’s deep sleep has an impact on whether secretion of the growth hormone somatotropin occurs at appropriate levels. This hormone ensures that cellular renewal can take place to the extent which is necessary. This applies particularly to the cells of the immune system (less and poor quality sleep often also entails an increased susceptibility to infection). Although studies have failed to demonstrate an increase in growth hormone after exposure to whole body cold(40), this is not actually a prerequisite for allowing a normal cellular regeneration. The euphoric effect of whole body cryoapplications is probably due to an increased endorphin and serotonin effect, although it still needs to be said that the study results remain inconclusive. However, there is no doubt that individuals experience an elevated mood after they are given cryoapplications. 

Another interesting aspect is the behaviour of the energy metabolism under whole body cold exposure, and in more ways than just one. Two factors need to be emphasised here. On the one hand cold exposure means that less energy is required to cool the body, meaning that a greater amount of energy can be allotted towards physical performance(80). Secondly, the oxygen radicals that are continuously produced as a result of energy metabolism can be rendered harmless more reliably. Cooling brings about a modulating effect on the oxidative/antioxidative balance(15, 41, 43, 47, 87, 88). Amongst other things this effect is important for preventing primary disease since such oxygen radicals are indeed implicated in the induction of cardiovascular, metabolic and cancer disease (figure 7.4).

Regarding the effects of whole body cold exposure on skeletal muscle their increased blood perfusion emphasis should be placed on the activation of a-motoneurones. The increased blood perfusion brings about an improved regenerative capacity of the muscles as well as an increase in power performance. With the latter, however, a-motoneurone activation also plays a role, especially when the activity of this neurones starts to fall off at high power performance levels (figure 7.5).

More specific content of the book "Power from the Cold":

7.2 Whole body cold exposure and recommendations for its health-promoting use 

7.2.1 Primary prevention of diseases
7.2.2 Health spas
7.2.3 Fitness programmes
7.2.4 Wellness and spa facilities
7.2.5 Aesthetic and cosmetic medicine
7.2.6 Naturopathic procedures

Order your copy of "Power from the Cold - Whole body cryotherapy at -110 °C" by Prof. Dr. sc. med. Winfried Papenfuß at Amazon